﻿         	<h3> אמא בחיים? </h3>
        
            <div class="radiobuttons">
            
                <input type="radio" name="moms_alive" id="momlive1" value="0"/>
                <label class="radiolabel" for="momlive1">לא</label>
                <input type="radio" name="moms_alive" id="momlive2" value="1"/>
                <label class="radiolabel" for="momlive2">כן</label>
            
            </div>
            
            <label class="textlabel"><input type="text" name="moms_deathAge" maxLength="3" size="3"/><span>?באיזה גיל נפטרה</span><br/></label>
            
            <h3> ממה נפטרה? </h3>
            
            <div class="checkboxesdiv" id="moms_deathCause[]">
                <?php 
        		include("dcsList.html");
        	    ?>
            </div>
            
            <h3> מחלות רקע אם </h3>
            
            <div class="radiobuttons">
            
                <input type="radio" name="moms_background" id="momback1" value="0"/>
                <label class="radiolabel" for="momback1">אין</label>
                <input type="radio" name="moms_background" id="momback2" value="1"/>
                <label class="radiolabel" for="momback2">יש</label>            
                
            </div>
            
            <h3> ?אילו </h3>
            
            <div class="backgroundDiseases" id="moms_diseases[]">
            	<?php 
        		include("dList.html");
        	    ?>
            </div>
